US Study: Teens more likely to use e-cigarette brand Juul than older age groups

Parliamentary Activity

Parliamentary Questions

UK

Budget: new tobacco duty for heated tobacco

A new (tobacco) duty for heated tobacco will come into force in July next year, it was announced in the recent Budget. The new tax applies to tobacco use in heat-not-burn products such as Philip Morris’ IQOS device.

The tax will be set at the same level as hand rolling tobacco, which has risen to 3% above inflation, compared to 2% above inflation for manufactured cigarettes.

Canada could soon become the first country in the world to require cigarette manufacturers to include warnings about the dangers of tobacco on individual cigarettes. The federal government has launched a consultation process looking at regulations around warnings on tobacco products.

One of the ideas being floated in the consultation is a new requirement for health warnings to be included on individual cigarettes. It is suggested that “smoking causes cancer” could be the phrase included. Currently, Canada only mandates that such warnings be placed on or inside cigarette packaging.

Rob Cunningham, a senior policy analyst for the Canadian Cancer Society, describes the proposal as a “logical next step” for health warning requirements.

“It’s an incredibly cost-effective way to reach every smoker every day with the health message.” he said.

Shane De La Haye, assistant fund manager at Ashburton Investments, writes about the rise of vaping and what it means for investors in ‘big tobacco’ companies.

“The global cigarette industry has been in decline for the last five years. Cigarette demand peaked in 2012, with around six trillion cigarettes being consumed worldwide. Since then, the volume of consumption has declined by 9.2% to 5.4 trillion cigarettes in 2017. The decline in volume has been driven by a number of factors including rising regulation, higher excise duties, growing consumer health consciousness, as well as the availability of cheaper alternatives.

“Smoking rates in the US and UK are currently at their lowest levels in years, at 15.5% and 15.8% respectively. Vaping has become a popular alternative for smokers seeking to quit the habit – the cost of maintaining a vaping habit is considerably cheaper than traditional smoking.

“The rapid growth of the vaping industry has been a double-edged sword for large tobacco companies. On one hand, the popularity of vaping has provided much needed growth within the industry, but at a cost, given the margin dilution. Rising demand for vaping has also resulted in cannibalisation from the traditional cigarette businesses, exacerbating the size and speed of volume declines within factory made cigarettes. As a result, we do not expect the rising demand for vaping to arrest the long-term decline in the global tobacco industry.”

US Study: Teens more likely to use e-cigarette brand Juul than older age groups

A study looking at e-cigarette use among American teenagers and adults has found a relatively higher level of experimentation and use of Juul e-cigarettes amongst younger age groups. The study looked at more than 13,000 people.

Amongst the respondents aged 15-17 years, 10% had previously experimented with Juul and this fell around 3% for those aged 25-34 years.

To ask the Secretary of State for Health and Social Care, if he will make an estimate the number and proportion of people in receipt of nicotine replacement products dispensed via the NHS who have subsequently quit cigarettes for at least 3 months.

To ask the Secretary of State for Health and Social Care, if he will make an assessment of the smoking cessation treatments available through the NHS that are most effective at (a) three months, (b) six months and (c) one year after the patient initially stops smoking.

To ask the Secretary of State for Health and Social Care, what estimate his Department has made of the total cost per patient of smoking cessation in terms of the (a) medication and (b) staff time involved in the dispensing of such products in the last year for which information is available.

Answered by: Steve Brine, The Parliamentary Under-Secretary for Health and Social Care

Norman Lamb (North Norfolk)
To ask the Secretary of State for Health and Social Care, if he will make an assessment of the relative cost effectiveness of the smoking cessation treatments available on the NHS; and if he will make a statement.

Answered by: Steve Brine, The Parliamentary Under-Secretary for Health and Social Care
The National Institute for Health and Care Excellence guideline NG92 provides a summary of the relative effectiveness of individual stop smoking medications (when used both with or without behavioural support), compared to effectiveness of no medication. This summary and accompanying guidance is available at the following link:

Claims by the tobacco industry that heated tobacco products (HTPs) are safer than conventional cigarettes may not be supported by the industry’s own data and are likely to be misunderstood by consumers, according to new research.

“Until now, most of the published research on HTPs had been done by tobacco companies,” said Glantz Stanton A. Glantz, director of the UCSF Center for Tobacco Control Research and Education.

Editorial note: a review of the evidence on heat not burn products by the UK Committee on Toxicology concluded that there was limited evidence in relation to these products but that there was likely to be some health harms from use, but those harms were likely to be lower than smoking.

Leading e-cigarette manufacturer Juul spent half a million dollars on lobbying (in the US) last quarter — up 167% from the previous quarter — as regulators consider restrictions on the industry to stem a perceived surge in American teens using the devices.

In quarter three, Juul spent $560,000, according to a lobbying disclosure form. That compares with the $210,000 it spent in the previous quarter, according to a filing. The company focused its efforts on e-cigarette and vaping regulation, as well as tariffs on products manufactured in China, it said in the disclosure.

Lawmakers, including Senate Minority Leader Chuck Schumer, have urged the Food and Drug Administration to ban sweet nicotine flavours they say entice young people to use e-cigarettes. In September, FDA Commissioner Dr. Scott Gottlieb announced the agency would crack down against teen use that he said has reached “epidemic levels.”

New research adds to the body of evidence showing that young people are particularly vulnerable to tobacco companies’ product innovations.

The study examined young adults’ responses to flavour capsule cigarettes. When crushed, these capsules add a flavour (typically fruit or menthol) to the cigarette smoke inhaled; this type of cigarette can reduce the harshness of smoking.

In the study there were 425 smokers and 390 susceptible non-smokers*. The smokers preferred unflavoured cigarettes to the capsule flavours tested, while susceptible non-smokers showed the reverse pattern and preferred the flavoured capsule cigarettes to the unflavoured option. Susceptible non-smokers were more than three times as likely to choose a “fruit burst” or “pineapple and mango” flavour than an unflavoured cigarette.

*Susceptible non-smokers were respondents who had never smoked regularly but gave responses other than ‘Definitely would not’ or ‘Definitely will not’ when asked if they would smoke a cigarette offered to them by a friend or if they would smoke a cigarette in the next 12 months

A group of would-be thieves were prevented from robbing a store in Belgium Saturday after the owner said he didn’t have enough money in the cash register and asked them to come back later.

The owner runs an e-cigarette shop on the outskirts of the Belgian city of Charleroi. He said six armed individuals walked into his store in the middle of the afternoon demanding money.

At 5:30 p.m. the group returned. Didier once again called their bluff and told the group it was still not closing time. “I berated them saying ‘you have to buy a watch.’ I said, ‘it’s 5:30 not 6:30,’ and they left,” he told RTL.

When the group returned for a third time, plain-clothes policemen were waiting to apprehend them. Five people were arrested, including a minor, according to local media. The sixth alleged offender ran away.

Kevin Barron Chair, Committee on Privileges
Will the Minister tell me whether the withdrawal of funding for the Healthy Futures programme in the north-west and Public Health Action in the south-west likely to help or hinder us meeting the smoking cessation targets in the tobacco control programme?

Steve Brine The Parliamentary Under-Secretary for Health and Social Care
This comes back to the matter of public health budgets—£16 billion during the current spending review period, with local authorities best placed to make local decisions on what is needed in their local area. That is the same in the right hon. Gentleman’s area as it is in mine.

Bob Blackman Conservative, Harrow East
The recent report from the Royal College of Physicians, “Hiding in plain sight: Treating tobacco dependency in the NHS”, made clear the cost savings and health benefits there would be if doctors identified smokers and referred them to smoking cessation services, so will next month’s plan include that, particularly for pregnant women and mental health patients?

Steve Brine, The Parliamentary Under-Secretary for Health and Social Care
As my hon. Friend, the chair of the all-party group on smoking and health, knows, those groups are key to delivering our tobacco control plan. We are not complacent at all; the delivery plan that was published in June sets out the actions that different agencies will take to deliver the five-year plan, and that absolutely includes mentor cessation services.

Obesity to overtake smoking as biggest preventable cause of cancer in women by 2043

Opinion: RIP smoking, a lethal pastime. But strangely, some of us will mourn it

International

Global treaty against illicit tobacco trade kicks in this week

Study: ‘Heat-not-burn’ devices still damage lungs

UK

Warning on link between multiple sclerosis and smoking

The link between smoking and multiple sclerosis (MS) is “clearer than ever”, with those who smoke more likely to develop the condition and become disabled more quickly, a charity has warned.

The MS Society said it has completed a major evidence review into the connection between smoking and the chronic lifelong and disabling condition, which affects the brain and spinal cord and has no cure. One study found that quitting smoking could delay the onset of secondary progressive MS – a form of the condition that has no treatment – by as much as eight years.

Ahead of October’s ‘Stoptober’ campaign, the MS society is warning that smoking can make MS more active and speed up the accumulation of disability.

Obesity to overtake smoking as biggest preventable cause of cancer in women by 2043

A report by Cancer Research UK has concluded that by 2043, excess weight could cause more cancers in women in the UK than smoking. Being overweight/obese is currently the second biggest cause of cancer in the UK, accounting for 6% of cases in 2015.

Currently for UK females, 12% of cancer cases are caused by smoking and 7% caused by obesity – only a 5-percentage point gap between the causes. A ‘takeover’ of obesity as the principle risk factor for male cancers is likely to happen much later; smoking is currently estimated to cause almost twice as many cancers as excess weight in men.

A spokesman for NHS England said: “Obesity is… one of the greatest public health challenges of our generation, placing people at much greater risk of cancers, heart attacks and other killer conditions as well as Type 2 diabetes.”

“According to Public Health England, smokers will soon be “eradicated”: the last smoker in the country quitting by the year 2030.

Despite less than 15% of adults admitting to being smokers, to me, 12 years to full abstinence seems rather fleet for a community not known for its speed. The cultural pull of tobacco, its hardiness in the face of hostility, may be weaker than it once was – those who would have smoked until they dropped are mostly now fogged in clouds of vape – but its survival instincts are those of a cockroach in the aftermath of an atomic strike. Eleven years ago, I watched as pubs erected smoking shelters for the incoming smoking ban; I don’t see them pulling them down in the near future.

For cigarettes are the grand delusion. Smoke one and you think you’re Audrey, Marlon, Winona; but more likely you are Farage – wheezing, gusting into smokefree zones with your sweet-sour stink, gazed at pityingly by the given-up and never smoked. But it doesn’t matter, you keep on. Keep up the ghost of your youth, show off your streak of non-conformity. Though they become mundane, a part of a routine, cigarettes still have that magic, that transformative power. It’s why people daily, gladly, inch themselves closer to the grave.

We will not mourn the passing of so lethal a pastime; an activity that has killed so many friends, family and lovers. And yet some of us will miss it so. The contradictions of the smoker!”

A global treaty to tackle the illegal tobacco trade kicks in this week, with the World Health Organization hailing it as “game-changing” in eliminating widespread health-hazardous and criminal activity.

The Protocol to Eliminate Illicit Trade in Tobacco Products achieved the 40 ratifications needed for it to take effect in June and will come into force on Tuesday 25 September. About 10% of the global cigarette market is estimated to go through illicit trade, according to Vera Luiza da Costa e Silva, who heads the FCTC secretariat.

Researchers have analysed data submitted by Philip Morris International to the U.S. Food and Drug Administration. The data was submitted when the company was trying to win regulatory approval to market its I-Quit-Ordinary Smoking (IQOS) product as a safer alternative to traditional cigarettes.

The data shows that when smokers switched from traditional cigarettes to “heat-not-burn” devices, there was no evidence of improvements in lung function or reductions in inflammation that can signal tobacco-related blood vessel damage.

“Even if a patient could switch completely from regular cigarettes to heat-not-burn products, Philip Morris International’s own data shows that there will continue to be significant health risks associated with these products,” said lead study author Dr. Farzad Moazed of the University of California, San Francisco.

West Midlands: Budget cut as plans to launch digital stop smoking service approved in Sandwell

“Sin” taxes are less efficient than they look, but they do help improve public health

International

US: Smokeless tobacco warning label may have misled consumers for years

Australia: Six tonnes of tobacco seized from illegal crops in Northern Territory

Opinion: How the tobacco industry has changed its marketing strategy across the globe

UK

West Midlands: Budget cut as plans to launch digital stop smoking service approved in Sandwell

Smokers in Sandwell could soon be offered online quit support after councillors agreed to re-commission its Stop Smoking service. It comes after cabinet members gave the go-ahead to proposals to cut its stop smoking budget by £360,000 and search for a new bidder to deliver the service.

The Stop Smoking service will be re-commissioned when the current contract comes to an end next April, councillors agreed on Wednesday.

Councillor Elaine Costigan, Sandwell council’s cabinet member for public health and protection, said: “Smoking cessation remains a key priority areas for Sandwell council public health. The proposed adjustments to the budget for the Stop Smoking service reflect a need to correct-size the allocation for this particular service. However, the new service will target hard-to-reach groups where smoking prevalence continues to remain high. We will also develop a digital self-help offer to reach those who don’t access traditional services.”

“Sin” taxes are less efficient than they look, but they do help improve public health

Governments hope that just as taxes on alcohol and tobacco both generate revenue and reduce smoking and drinking, so sugar taxes will help curb obesity.

As policy instruments, sin taxes can be blunt. People who only occasionally drink or smoke are taxed no differently from heavy smokers and drinkers, whilst some economists are concerned that sin taxes affect low-income households most.

However, sin taxes do change behaviour. Estimates vary from study to study, but economists find that on average, a 1% increase in prices is associated with a decline of around 0.5% in sales of both alcohol and tobacco. Economic models assume that people know what they are doing, but humans struggle with behaviour change. Most smokers are aware of the health risks, but many still find it hard to quit.

US: Smokeless tobacco warning label may have misled consumers for years

In 1986, the U.S. government passed legislation requiring a series of warnings for smokeless tobacco products, one of which advised “This product is not a safe alternative to cigarettes.”

That warning, however, obscured an important distinction—that cigarettes are much more harmful to health than smokeless tobacco products. Over the 30-plus years since, the American public has mostly been unaware that smokeless tobacco is much less harmful than cigarettes, one of the nation’s leading tobacco policy experts argues in a new paper.

“It is important to distinguish between evidence that a product is ‘not safe’ and evidence that a product is ‘not safer’ than cigarettes or ‘just as harmful’ as cigarettes,” says the paper author, Lynn Kozlowski, professor of community health and health behavior at the University at Buffalo’s School of Public Health and Health Professions. “The process at the time of the establishment of official smokeless tobacco warnings in the 1980s paid no attention to this distinction,” Kozlowski adds. “The American public has become mostly unaware that smokeless tobacco is much less harmful than cigarettes.”

Australia: Six tonnes of tobacco seized from illegal crops in Northern Territory

Six tonnes of illegal tobacco leaves and vast fields of mature plants worth more than $13m in lost tax have been seized on a rural property in the Northern Territory. This was the first successful strike by a taskforce bringing together agencies including the Australian Tax Office and Australian Border Force. The illegal tobacco trade costs the federal government about $600m a year in lost revenue.

Australian Border Force assistant commissioner Sharon Huey said people may think it fairly harmless to purchase a cheap pack of illegal cigarettes, but warned the consequences could be dire. “The profits they make are going into more serious and more insidious types of crime,” she said. “We shouldn’t underestimate the impact of illicit tobacco.”

Opinion: How the tobacco industry has changed its marketing strategy across the globe

Tirumalai Kamala, Immunologist, Ph.D. Mycobacteriology, discusses which countries have done the best at eliminating smoking.

“Among the wiliest of industry operators, the tobacco industry started expanding its markets in China, Africa and Latin America as the noose began tightening around its activities in North America and Western Europe.

Being a formidable litigant helped it in this expansion, enabling it to successfully hide for decades the extent to which it knew full well that what it peddles is poison. In practical terms, this means that even as public policies in some countries started gaining ground against smoking, rates increased in others which either lacked such regulations and/or could be easily manipulated through PR campaigns.

Illustrative examples from Bhutan and Brazil show how public policies on smoking could either unwittingly increase it or work as they should and reduce it.”

Indonesia: Tobacco use becoming part of the ‘rite of passage’ for some rural boys

Parliamentary Activity

Parliamentary Question

UK

NHS ‘Stop Smoking’ ads working in Essex

Half of young people surveyed in Essex say they’ve been put off taking up smoking by national NHS ‘Stop Smoking adverts’ on TV. The YEAH!3 report, by Healthwatch Essex, found the adverts have discouraged young people from ever taking up smoking, many said that constant reminders of the dangers prevented them from starting. The visual impact of warnings on cigarette packets was also a common factor reported to discourage young people from smoking.

Dr David Sollis, CEO of Healthwatch Essex, said: “It is very encouraging to hear that some of the adverts currently being used by the NHS are proving successful in deterring young people from smoking. That was a very clear message that came out of the report, which is really positive. It seems, for young people who already smoke, being warned of the long-term dangers is not always the strongest incentive to quit. In fact, we found that tailoring smoking-cessation information to include more immediate side effects and consequences may benefit this group more.”

British American Tobacco has said it received a “substantial equivalence” clearance from the U.S. Food and Drug Administration for an new version of its carbon-tipped tobacco heating product called Eclipse.

This means the product can be legally marketed in the US and BAT said it would test launch Eclipse in the United States within the next 12 months.

A study by the VA Center of Innovation for Veteran-Centered and Value-Driven Care in Seattle has found that patients hold misconceptions around the benefits and limitations of lung cancer screenings. Regular cancer screenings can lower chance of death from lung cancer due to earlier detection expanding treatment options, but cannot reduce the risk of developing lung cancer for people who smoke.

To test patients’ actual knowledge about lung cancer, the researchers surveyed 83 smokers after their lungs were screened, with a series of questions. Nearly half (47%) answered the question “For people over age 55 who are current smokers, which is more likely to prevent the most premature deaths – lung cancer screening or quitting smoking?” incorrectly. This means nearly half of patients believed lung cancer screenings were at least as good as quitting smoking as a way of protecting against death.

Indonesia: Tobacco use becoming part of the ‘rite of passage’ for some rural boys

Indonesia has one of the highest smoking rates in the world, with 63% of men (but just 5% of women) reported to be smokers. It’s the fifth largest tobacco market in the world, in part due it’s large, expanding, population of 260 million.

Some cultures in Indonesia regard circumcision as the mark of when a boy becomes a man and often at this time boys will receive gifts. In tobacco-producing district in Magelang, Central Java, smoking has become part of the rite of passage for boys and cigarettes are now a common gift.

The Magelang regency administration launched an intensive campaign against children smoking early this year including targeting junior high school students to explain the dangers of smoking.

Martyn Day Scottish National Party, Linlithgow and East Falkirk
To ask the Chancellor of the Exchequer, how he plans to ensure that the UK tobacco product track and trace system as required by Article 8 of the WHO FCTC Protocol to Eliminate the Illicit Trade in Tobacco Products will be fully independent from the tobacco industry.

Robert Jenrick The Exchequer Secretary
The government is committed to meeting the requirements for independence from the tobacco industry as per Article 8 of the WHO FCTC Protocol to Eliminate the Illicit Trade in Tobacco Products.

The track and trace system will be implemented under the EU Tobacco Products Directive. The implementing legislation for the Directive specifies strict and comprehensive criteria by which independence from the tobacco industry is determined. Providers of the track and trace system will need to demonstrate to HM Revenue & Customs that they satisfy this criteria both before and during the period they provide the services required as a condition of holding the respective contracts.

UN-backed treaty against illicit tobacco trade set to take effect in September

Japan: First anti-smoking law gets go ahead – but it is lax and partial

USA: Campaign helps smokers to quit

UK

Philip Morris International under fire over ‘disgraceful’ PR stunt

Philip Morris International (PMI), the world’s largest tobacco firm, has been accused of staging “a disgraceful PR stunt” by offering to help NHS staff quit smoking to help mark the service’s 70th birthday. PMI made an ‘offer’ in a letter sent to all NHS bodies in England and also to Simon Stevens and Matt Hancock.

Mark MacGregor, PMI’s director of corporate affairs in the UK and Ireland, said in the widely distributed letter: “To support the 70th anniversary of the NHS, we are keen to work with you to help the 73,000 NHS employees who currently smoke, to quit cigarettes. This would be a collaborative campaign: you would provide cessation advice for quitting nicotine altogether, and for smokers who do not quit we can help them switch to smoke-free alternatives.”

Paul Burstow, the former Liberal Democrat health minister in the coalition government, said in a letter to Simon Stevens: “Any such collaboration with the tobacco industry would be completely inappropriate and a breach of the UK government’s obligations as a party to the WHO FCTC.”

Bob Blackman, chair of the APPG on Smoking in Health said: “They have the cheek to say they want to support the 70th anniversary of the NHS, but it’s clearly just a commercial opportunity to use the NHS to promote their heated tobacco products.”

Steve Brine, the public health minister said he would tell NHS trusts not to get involved. Brine said: “Our aim to make our NHS – and our next generation – smoke-free must be completely separate from the commercial and vested interests of the tobacco industry.”

Deborah Arnott, chief executive of ASH said: “This is a disgraceful PR stunt. PMI is pretending partnership would benefit the NHS, when actually it would give them a massive commercial advantage. They could promote their own harm-reduction products as NHS-endorsed.”

The Government will take one of the world’s largest tobacco firms to court unless it stops illegally targeting UK consumers with tobacco adverts, a Minister has said.

Yesterday the Department of Health sent a formal order to Phillip Morris International, which makes Marlboro cigarettes, telling it to remove poster adverts for “healthier” tobacco products from shops around the UK. PMI has been supplying newsagents across Britain with window posters promoting new iQOS tobacco heaters.

The iQOS posters are in breach of a strict, long-standing ban on advertising tobacco and tobacco-related products, the Department for Health and the National Trading Standards Institute have confirmed.

Public Health Minister, Steve Brine, said: “We have been explicit that the promotion of tobacco products is unlawful – as my letter to Phillip Morris International makes abundantly clear. We expect PMI to stop this unlawful advertisement of tobacco products and we will not rule out legal action if they continue.”

Tobacco control group Fresh wants people in the North-East affected by smoking to share their real life experiences. The aim is to put smokers’ real stories at the heart of a ‘hard hitting’ new campaign later this year, warning of the dangers of smoking. They are hoping to hear from former smokers who have been personally affected by ill-health or family members whose loved ones have suffered from a smoking-related illness.

Ailsa Rutter, director of Fresh, said: “It is a brave step to share your experiences with others, but we know that it can have a powerful impact in encouraging others to quit. If you want to make a difference and are interested in backing the campaign, we would love to hear from you.”

Action against illegal tobacco in central Nelson has resulted in a further seizure in under a week at one shop, and a manufacturing operation being uncovered at another. An inspection by Lancashire County Council Trading Standards and Lancashire Police on Tuesday, July 17, found a further 88 packs behind the counter at one shop, after a raid the previous Thursday netted over 2,200 packs worth £10,000.

Officers then visited a second shop just outside Nelson town centre, where they found a production line for manufacturing packs of counterfeit rolling tobacco in an upstairs room.

Scotland has the highest rate of avoidable death in the UK and the figures are getting worse, a BBC analysis has found. In 2016, the rate stood at 301 deaths per 100,000 people, compared with 287 in 2014. Experts blame social deprivation, with easy access to alcohol, tobacco and fast food also a factor.

Dr Andrew Fraser, from NHS Health Scotland, said: “We know that people in poorer areas experience more harm from alcohol, tobacco and fast food than those in more affluent areas. Part of the reason for this is that it is easier to access the things that harm our health in those areas.”

“To prevent death, disease and harm we need to take actions where and when they are needed. We must address harm from alcohol, tobacco, being overweight or obese. However, these are often common factors, co-existing in communities, groups and individuals, and so we must also address the environment we live in.”

New figures from the Office for National Statistics show Dundee still has one of the highest rates of smoking in Britain, with more than one in five adults smoking. However, the number of smokers in Dundee is decreasing, due to a successful and sustained tobacco control strategy from the government. In 2011, 27.3% of Dundee’s population smoked 2017 and by this figure had dropped to 20.8%.

UN-backed treaty against illicit tobacco trade set to take effect in September

A UN-backed treaty aimed at stopping the illicit trading of tobacco products, is set to take effect on the 25th of September. The package of measures agreed by countries which 45 Parties and the European Union have ratified is known as the Protocol to Eliminate Illicit Trade in Tobacco Products. It was developed in response to a growing illegal trade in tobacco products, often across borders.

The Protocol aims to make the supply chain of tobacco products secure through a series of governmental measures. It requires the establishment of a global tracking and tracing regime within five years of its entry into force. Other provisions to ensure control of the supply chain include licensing, record keeping requirements, and regulation of internet-sales, duty-free sales and international transit.

Japan: First anti-smoking law gets go ahead – but it is lax and partial

Japan has approved its first national legislation banning smoking inside of public facilities, but the watered-down measure excludes many restaurants and bars and is seen as toothless.

The legislation aims to lower secondhand smoking risks ahead of the 2020 Tokyo Olympics amid international calls for a smokefree Games. But ruling party lawmakers with strong ties to the tobacco and restaurant industries opted for a weakened version.

The new national law bans indoor smoking at schools, hospitals and government offices. Smoking will be allowed at existing small eateries, including those with less than 100 square meters (1,076 square feet) of customer space, which includes more than half of Japanese establishments. Larger and new eateries must limit smoking to designated rooms.

Violators can face fines of up to 300,000 yen ($2,700) for smokers and up to 500,000 yen ($4,500) for facility managers. The ban will be implemented in stages and fully enter into force in April 2020.

The ongoing Tips from Former Smokers (Tips) campaign, which features stories of former smokers living with smoking-related diseases and disabilities, has had a considerable impact, according to a report from the U.S. Centers for Disease Control and Prevention.

The Tips campaign engages health care providers so that they can encourage their smoking patients to quit. In addition, resources are provided for health care providers, public health professionals, and mental health providers. More than nine million smokers were estimated to have attempted to quit during 2012 to 2015 as a result of the Tips campaign; conservative estimates indicate that over half a million smokers have quit for good.

There were 267,594 calls attributable to the Tips campaign in 2017, which ran from January 9 to July 30. An estimated 1.83 million smokers attempted to quit and 104,000 quit for good as a result of the 2014 campaign. Non-smokers reported increased conversations with family and friends about the dangers of smoking and had greater knowledge of smoking-related diseases as a result of the Tips 2012 campaign. An estimated 1.64 million smokers made a quit attempt and 100,000 smokers quit for good as a result of the 2012 campaign.

“Smokers who have seen Tips ads report greater intentions to quit within the next 30 days and next six months, and smokers who have seen the ads multiple times have even greater intentions to quit,” according to the report.

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